Stemmed pyrocarbon hemiarthroplasty for glenohumeral arthropathy: a systematic review and meta-analysis
- 1Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
Abstract
Background: Stemmed pyrocarbon hemiarthroplasty (sPyC-HA) has emerged as a glenoid-preserving option for young, active patients with glenohumeral arthropathy. Prior reviews have included mixed pyrocarbon implant types and have generally summarized outcomes descriptively. No prior systematic review and meta-analysis has focused exclusively on sPyC-HA with quantitative pooled analysis of clinical and survivorship outcomes.
Methods: A systematic review and meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Scopus, and Google Scholar were searched through February 2026. Eligible studies reported outcomes of sPyC-HA for glenohumeral arthropathy or related indications. Overlapping institutional cohorts were identified and managed to avoid repetitive counting of patient data. Revision rate were pooled using random-effects models with Freeman-Tukey double-arcsine transformation. Continuous outcomes were pooled using inverse-variance weighted random-effects models with Hartung-Knapp confidence intervals (CIs). Methodological quality was assessed using the Methodological Index for Non-Randomized Studies criteria.
Results: Seventeen studies met the inclusion criteria for qualitative review. Of these, 10 unique studies comprising 789 shoulders at a mean age of 52.9 years with a mean follow-up of 38 months were included in the meta-analysis. The pooled all-cause revision rate was 5.0% (95% CI 3.3%-7.4%; I2 = 24.1%), and the pooled atraumatic revision rate was 4.5% (95% CI 3.1%-6.6%; I2 = 15.7%). The pooled final absolute Constant score was 77.5 points (95% CI 67.6-87.4; I2 = 77.7%), with a mean improvement of 42.5 points (95% CI 29.5-55.5; I2 = 90.3%) at final follow-up. Pooled final forward flexion was 149.7° (95% CI 135.9°-163.5°; I2 = 86.5%), with a mean improvement of 45.3° (95% CI 28.7°-62.0°). The pooled improvement in visual analog scale/numeric rating scale pain score was −5.08 points (95% CI -5.98 to −4.17; I2 = 60.7%). Among studies reporting Kaplan-Meier survivorship, revision-free survival ranged from 92.2% at 3 years to 89.4% at 10 years. Across multiple independent cohorts, radiographic glenoid erosion progression was not associated with functional outcomes. Humeral head oversizing was consistently noted as the most modifiable factor associated with glenoid erosion and revision.
Conclusion: sPyC-HA is associated with low pooled revision rates, improved functional outcomes, and encouraging survivorship data at short-term to mid-term follow-up. Oversizing of the humeral head is associated with a higher revision rate, and intra-operative humeral head size choice is a modifiable surgical factor. Long-term survivorship remains uncertain, and continued follow-up is needed before sPyC-HA can be established as a viable alternative to both anatomic total shoulder arthroplasty and conventional cobalt-chromium hemiarthroplasty in this challenging patient population.
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BibTeX
@article{rice2026stemmed,
title = {{Stemmed pyrocarbon hemiarthroplasty for glenohumeral arthropathy: a systematic review and meta-analysis}},
author = {Samuel W. Rice and Gregory Iovanel and Jake A. Ayisi and Daniel Aaron and Wayne W. Chan and Ankur S. Narain},
journal = {Journal of Shoulder and Elbow Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100108},
url = {https://doi.org/10.1016/j.jsea.2026.100108},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Stemmed pyrocarbon hemiarthroplasty for glenohumeral arthropathy: a systematic review and meta-analysis
AU - Samuel W. Rice
AU - Gregory Iovanel
AU - Jake A. Ayisi
AU - Daniel Aaron
AU - Wayne W. Chan
AU - Ankur S. Narain
PY - 2026
DA - 2026/09/30
JO - Journal of Shoulder and Elbow Arthroplasty
DO - 10.1016/j.jsea.2026.100108
UR - https://doi.org/10.1016/j.jsea.2026.100108
AB - Background: Stemmed pyrocarbon hemiarthroplasty (sPyC-HA) has emerged as a glenoid-preserving option for young, active patients with glenohumeral arthropathy. Prior reviews have included mixed pyrocarbon implant types and have generally summarized outcomes descriptively. No prior systematic review and meta-analysis has focused exclusively on sPyC-HA with quantitative pooled analysis of clinical and survivorship outcomes. Methods: A systematic review and meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Scopus, and Google Scholar were searched through February 2026. Eligible studies reported outcomes of sPyC-HA for glenohumeral arthropathy or related indications. Overlapping institutional cohorts were identified and managed to avoid repetitive counting of patient data. Revision rate were pooled using random-effects models with Freeman-Tukey double-arcsine transformation. Continuous outcomes were pooled using inverse-variance weighted random-effects models with Hartung-Knapp confidence intervals (CIs). Methodological quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Results: Seventeen studies met the inclusion criteria for qualitative review. Of these, 10 unique studies comprising 789 shoulders at a mean age of 52.9 years with a mean follow-up of 38 months were included in the meta-analysis. The pooled all-cause revision rate was 5.0% (95% CI 3.3%-7.4%; I2 = 24.1%), and the pooled atraumatic revision rate was 4.5% (95% CI 3.1%-6.6%; I2 = 15.7%). The pooled final absolute Constant score was 77.5 points (95% CI 67.6-87.4; I2 = 77.7%), with a mean improvement of 42.5 points (95% CI 29.5-55.5; I2 = 90.3%) at final follow-up. Pooled final forward flexion was 149.7° (95% CI 135.9°-163.5°; I2 = 86.5%), with a mean improvement of 45.3° (95% CI 28.7°-62.0°). The pooled improvement in visual analog scale/numeric rating scale pain score was −5.08 points (95% CI -5.98 to −4.17; I2 = 60.7%). Among studies reporting Kaplan-Meier survivorship, revision-free survival ranged from 92.2% at 3 years to 89.4% at 10 years. Across multiple independent cohorts, radiographic glenoid erosion progression was not associated with functional outcomes. Humeral head oversizing was consistently noted as the most modifiable factor associated with glenoid erosion and revision. Conclusion: sPyC-HA is associated with low pooled revision rates, improved functional outcomes, and encouraging survivorship data at short-term to mid-term follow-up. Oversizing of the humeral head is associated with a higher revision rate, and intra-operative humeral head size choice is a modifiable surgical factor. Long-term survivorship remains uncertain, and continued follow-up is needed before sPyC-HA can be established as a viable alternative to both anatomic total shoulder arthroplasty and conventional cobalt-chromium hemiarthroplasty in this challenging patient population.
SN - 2471-5492
ER -